1、 双核素心肌断层显像方法双核素心肌断层显像方法 仪器仪器 采用 elscint varicam 双探头SPECT (GE公司提供），配备超高能准直器 (UHEC)。双探头采用90度垂直位(L-mode)进行分步采集。体位体位患者取仰卧位，双手抱头充分暴 露心前区。探头尽量贴近患者以最大限度增 加计数，减少噪声。采集条件采集条件采 集 程 序 为 系统 自 带双核素断层采集程序(HEI/MIBI ECT Dual Isotope);能峰为140kev 及 511kev、窗宽20%；矩阵6464；采集时间为 30-35秒；探头旋转角度为90度(由左前至右后共180度）、每3度一帧分步采集。处理条件
2、处理条件 采用滤波反投影法进行重建，分别得到 水平长轴、短轴及垂直长轴三个断面的 图象；滤波函数采用butterworth,截止频 率为0.45,权重值为4.5。血糖调节血糖调节 静脉注射静脉注射9999TcTcm m-MIBI20mCi-MIBI20mCi，4545分钟分钟后测定患者的血糖浓度，将血糖浓度控后测定患者的血糖浓度，将血糖浓度控制在制在7.9-8.87.9-8.8mmolmmol/L/L之间。如果患者血糖之间。如果患者血糖浓度低于浓度低于7.87.8mmolmmol/L/L需要口服葡萄糖补充，需要口服葡萄糖补充，如果血糖浓度高于如果血糖浓度高于8.98.9mmolmmol/L/L
3、则需要皮下则需要皮下注射胰岛素降低血糖浓度。在血糖控制注射胰岛素降低血糖浓度。在血糖控制后后10-15min10-15min，静脉注射，静脉注射1818F-FDG 6-8mCiF-FDG 6-8mCi，一小时后显像。一小时后显像。Case 1 LJZHistory:67 year-old male,2 years history of progressive typical exertional angina and inferior myocardial infarction.Cardiac risk factors included age,known history of CAD.The
4、 resting ECG revealed sinus bradycardia and evidence of an old inferior myocardial infarction.Clinical courseCardiac catheterization revealed a 100%LAD lesion and 90%narrowing of the right coronary artery.The patient underwent successful coronary bypass surgery.DISA imaging protocol MIBI Plasma gluc
5、ose FDG DISA 0 40 60 120(min)Plasma glucose 140160mg%.Plasma glucose level 140mg%,50-75g glucose.Diabetes mellitus,Insulin was subcutaneously injected according to the plasma glucose.Case 2 WCDA 62-year-old female with no past cardiac history presented with a 6 month history of exertional chest pain
6、 with both typical and atypical feature.Cardiac risk factors included hypercholesterolemia,family history of CAD.The resting ECG revealed normal.Hospital courseCardiac catheterization:LAD 90%,LCX 80%,RCA 60%Clinical diagnosis:CAD Angina pectorisThe patient underwent CABG.Case 3 LJX44-year-old male w
7、ithout known CAD presented with a 3 year history of atypical chest pain and dyspnea on exertion.Cardiac risk factors included cigarette smoking.No history of hypertension,diabetes mellitus.ECG revealed nonsepecific T wave abnormalities.Echocardiography revealed dilated left ventricle and atrium.Seve
8、re left ventricular hypokinesis.LVEF=25%Clinical courseCardiac catheterization:Three coronary vessels.There was a 80%LAD lesion,90%narrow of the left circumflex artery and 50%lesionin the right coronary artery.One month later the patient underwent CABG.Case 4 GTBA 58-year-old man presented with mild
9、 congestive heart failure 1 year.He had often experienced a chest tightness,and shortness of breath.Cardiac risk factors included age and hypercholesterolemia.The resting ECG revealed LBBB.The resting MIBI-FDG SPECT(DISA)was performed.Clinical courseCardiac catheterization:three coronary artery dise
10、ase,LAD 80%LCX 60%RCA 95%The patient underwent PTCA of mid RCA lesion.Case 5 A man 52-year-old presented with progressive exertional angina despitemaximal medical therapy.He had had two previous myocardial infarction.Cardiac risk factors included known CAD,age,hypertension and family history of CAD.
11、His resting ECG revealed evidence of an old anterior myocardial infarction.Clinical courseCardiac Catheterization:100%LAD lesion,100%proximal circumflex marginal lesion.Ventriculogram revealed an anteroapical aneurysm.The patient underwent CABG andneurysmectomy.Case 6 CBKA 66-year-old without know C
12、AD presented with recent onset of chest fullness on exertion,which was relieved with rest.Cardiac risk factors included diabetes mellitus and tobacco use.The resting ECG was normal.Clinical courseCardiac catheterization:90%stenosis of LAD.The patient underwent successful of PTCA and stent of the pro
13、ximal LAD lesion.Case 7 HsyiA 67 year-old male presented with atypical chest pain and shortness of breath.He had experienced an anterior myocardial infarction 8 year prior.He had stopped smoking cigarettes,and his hyperlipidemia and hypertension were well controlled with medication.The resting ECG r
14、evealed an old anteriormyocardial infarction.Hospital courseCardiac catheterization:LAD 100%,LCX mid 90%stenosis.The patient was treated with medicine.Case 8 MzlA 46-year-old male with a history of myocardial infarction 2 years.Cardiac risk factors included cigarette smoking.The resting ECG revealed
15、 an old inferior myocardial infarction.Case 9 SltA 49-year-old male had had an anterior myocadial infarction 1 year previously.Recently he began to hypotension and mild congestive heart failure.Cardiac risk factors:age,positive family of CAD.Hospital courseCardiac catheterization:(1)LAD 100%occulsio
16、n;(2)anteroapical aneurysm.Cardiac death,one month later.Case 10A 58-years-old male with hypertension of 8 years duration had an inferior myocardial infarction 2 years before.Cardiac risk factors included age andhypertension.The resting ECG revealed an old inferior myocardial infarction.Hospital cou
17、rseCoronary angiography showed three vesslesstenosis.LAD 70%LCX 60%RCA 95%The patient underwent PTCA of RCA.Cedars-Sinai法门控心肌断层显像结果左室局部功能比较左室局部功能比较 7777例患者的例患者的539539段心肌节段中，段心肌节段中，门控门控MIBIMIBI显像和显像和LVGLVG的符合率为的符合率为82.9%82.9%；门控门控FDGFDG显像和显像和LVGLVG的符合率为的符合率为78.9%78.9%。LVGLVG和门控和门控MIBIMIBI比较比较 门控门控MIB
18、I LVG 0 1 2 3 0 249 19 10 0 1 0 98 18 0 2 0 26 61 9 3 0 0 12 39两者符合率达两者符合率达82.9%LVAGLVAG和门控和门控FDGFDG比较比较 门控门控MIBI LVG 0 1 2 3 0 231 23 14 8 1 0 98 18 0 2 0 21 66 9 3 0 0 21 30两者的符合率为两者的符合率为78.9%造影结果 患者于患者于20002000年年1111月月5 5日行冠状动脉日行冠状动脉+左心室造影，左心室造影，1111月月1010日行门控双核素显日行门控双核素显像。造影发现像。造影发现LAD LAD 狭窄狭窄3
19、0-40%30-40%，RCARCA（-），），LCXLCX（-）；）；LVEF=38%LVEF=38%，前侧壁、，前侧壁、心尖部室壁瘤形成。心尖部室壁瘤形成。造影结果 20012001年年2 2月月2 2日行冠状动脉日行冠状动脉+左心室左心室造影：造影：RCARCA全程斑块；全程斑块；LADLAD起始至中段起始至中段扩张狭窄交替，最窄扩张狭窄交替，最窄70-80%70-80%；LCXLCX全程全程斑块。斑块。LVEF=32%LVEF=32%，前侧壁、间隔、膈，前侧壁、间隔、膈面运动减弱，心尖运动消失。面运动减弱，心尖运动消失。20012001年年2 2月月6 6日行门控双核素显像。日行门控双核素显像。结论结论 应用应用9999m mTcTc-MIBI/-MIBI/1818F-FDG F-FDG 双核素门双核素门控心肌显像，可以在了解左心室心肌的控心肌显像，可以在了解左心室心肌的血流灌注和代谢情况的同时，提供左心血流灌注和代谢情况的同时，提供左心室功能的重要信息，所得到的室功能的重要信息，所得到的LVEFLVEF和局和局部功能有较高的准确性。部功能有较高的准确性。
